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While we currently have a waitlist for our shelter program, if you are in need of housing, please fill out the form below and we will contact you within 3 business days to discuss next steps. 

Intake Questionnaire

Please answer each question to the best of your ability and one of our team members will respond as soon as possible. This information will be used only by Family Promise of Butler County staff to determine eligibility and will be held confidentially outside of this purpose.

Have you experienced any of the following?

I consent to the disclosure of my information to allow necessary information to be uploaded to HMIS (Homeless Management Information System) so that Family Promise of Butler County staff can assist me in identifying the best resources. Only trained case managers will have access to my information on HMIS.

Thanks for submitting!

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